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PubMed1998

Integrating osteopathic training into family practice residencies.

BACKGROUND AND OBJECTIVES: Since the mid-1980s, the number of osteopathic graduates has increased, and the number of osteopathic hospitals has decreased. This has led to an increasing number of osteopathic students seeking training in Accreditation Council for Graduate Medical Education (ACGME) family practice residency programs. In response to these developments and to a declining pool of allopathic applicants in the early 1990s, at least 35 ACGME programs have completed the American Osteopathic Association (AOA) accreditation process as approved internship sites. This article describes 1) the rationale for becoming accredited, 2) the AOA accreditation process, 3) a model osteopathic curriculum, 4) potential difficulties, 5) issues to consider in approaching a decision to become AOA accredited, and 6) future trends in osteopathic graduate medical education.

Accreditation↗
PubMed1998

[Notes on the visitation of medical schools in 1997].

The members of the Visitation Committee who audited the medical education process in the Netherlands carefully formed their opinions based on a vast amount of information. Their judgement can be considered fair and well-balanced. Several critical remarks were made, especially on the coaching of students during their internships. The scientific education was also found wanting. Some faculties were given bad marks, and scores of recommendations were made. Surprisingly, however, the committee was of the opinion that students graduating from all faculties were equally and sufficiently competent to enter the medical workforce. It is recommended that next time this audit process be carried out on a much smaller scale.

Curriculum↗
PubMed1998

Prevalence and correlates of harassment among US women physicians.

BACKGROUND: Despite concerns about its prevalence and ramifications, harassment has not been well quantified among physicians. Previous published studies have been small, have surveyed only 1 site or a convenience sample, and have suffered from selection bias. METHODS: Our database is the Women Physicians' Health Study, a large (4501 respondents; response rate, 59%), nationally distributed questionnaire study. We analyzed responses concerning gender-based and sexual harassment. RESULTS: Overall, 47.7% of women physicians reported ever experiencing gender-based harassment, and 36.9% reported sexual harassment. Harassment was more common while in medical school (31% of gender-based and 20% for sexual harassment) or during internship, residency, or fellowship (29% for gender-based and 19% for sexual harassment) than in practice (25% for gender-based and 11% for sexual harassment). Respondents more likely to report gender-based harassment were physicians who were now divorced or separated and those specializing in historically male specialties, whereas those of Asian and other (nonwhite, nonblack, non-Asian, non-Hispanic) ethnicity, those living in the East, and those self-characterized as politically very conservative were less likely to report gender-based harassment. Being younger, born in the United States, or divorced or separated were correlated with reporting ever experiencing sexual harassment; those who were Asian or who were currently working in group or government settings were less likely to report it. Those who felt in control of their work environments, were satisfied with their careers, and would choose again to become physicians reported lower prevalences of ever experiencing harassment. Those with histories of depression or suicide attempts were more likely to report ever having been harassed. CONCLUSIONS: Women physicians commonly perceive that they have been harassed. Experiences of and sensitivity to harassment differ among individuals, and there may be substantial professional and personal consequences of harassment. Since reported rates of sexual harassment are higher among younger physicians, the situation may not be improving.

Adult↗
PubMed1995

Antonio de Gimbernat (1734-1816). Anatomist and surgeon.

While one of us (J.P.-L.) was completing his surgical internship at the Henry Ford Hospital of Detroit, Mich, during 1954 to 1956, he found with surprise that, although surgeons at the hospital could speak Gimbernat's ligament with reference to the treatment of crural hernia, practically none was aware that Antonio de Gimbernat was Spanish-Catalan, to be exact. Others ventured he might be French. We also observed, while attending the celebration of the centennial publication of Bassini's technique in Padua, Italy (1987), that a surprising number of European university professors also believed that Gimbernat was French. Since then, we who have held the same chair for more than 20 years at the Santa Cruz and San Pablo Hospital of Barcelona, Spain, that Gimbernat held in the 18th century have endeavored to vindicate the name of Antonio de Gimbernat i Arbós as the Spanish-Catalan anatomist and surgeon for whom a ligament was named and a surgical technique defined. When applied to the strangulated crural hernia, this surgical technique offers greater promise to the patient during surgery.

Anatomy↗
PubMed1984

The status of projective techniques: or, "wishing won't make it go away".

Analyzed predicted decline of projective techniques in usefulness and emphasis when viewed from several different perspectives: the academic community; members of APA Division 12; internship centers; the applied clinical setting; and private practitioners. An extensive review of empirical, survey, and position studies over the past two decades supports the utility of projective techniques, with the exception of the clinical academic setting. The apparent loss in status of projective assessment is attributed, in part, to changing roles and functions of clinical psychologists. Implications for graduate training are discussed.

Attitude of Health Personnel↗
PubMed2001

Clinical training and the duty to protect.

Given that the duty to protect is now a well established clinical and legal expectation, training in professional psychology should assist students in developing conceptual models for violence risk assessment and management. This report presents a training model incorporating recent advancements in risk assessment (such as the assessment of psychopathy), the need for basic legal understanding, and knowledge of specific risk management strategies. Additionally, academic and internship training programs in Michigan were surveyed by telephone about current training patterns. Preliminary results indicated program strengths in general awareness and training in risk factors. However, the data also suggested a need to formalize a faculty role in risk education, improve the training of students in relevant legal information, and establish coherent conceptual models of dealing with potential patient violence. It is argued that improving training of future professionals in this way will improve clinical practice, reduce legal liability, and improve public safety.

Duty to Warn↗
PubMed2002

The high cost of prescription privileges.

This article presents some data regarding the costs in the augmentation of programs aimed at equipping psychologist to prescribe medications. Data are presented relative to the financial burden it will place on students, universities, internship sites, and the consumers of psychological services.

Costs and Cost Analysis↗
PubMed2003

Clinical psychology in Spain.

A general view of the field of clinical psychology in present-day Spain is offered here. The field has experienced an enormous development over the past two decades. Many journals and specialized societies have been established, and a large number of professionals now are working in the field, most of them in private practice, but some in medical centers belonging to the Spanish national health service. This great expansion seems due mainly to the creation of a degree in psychology(1968) and the continuous flow of students demanding training in clinical subjects. A theoretical orientation toward a cognitive-behavioral approach seems to dominate, closely followed by those choosing a dynamic orientation. A large group of professionals dealing with health problems are reinforcing their idiosyncratic profile among the clinical psychology. A new study program to become a specialist in our field recently has been implemented and is just entering its initial stages (Internship in Psychology-PIR); it represents a significant improvement in the curriculum of the clinical psychology. All of these facts seem to prove the great vitality of this field in present-day Spain.

Humans↗
PubMed2004

Achieving competency in psychological assessment: directions for education and training.

This article provides an overview of issues related to the development and evaluation of competency in psychological assessment. Specifically, we delineate the goals, ideas, and directions identified by the psychological assessment work group in the Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology. This is one of a series of articles published in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference will appear in Professional Psychology: Research and Practice and The Counseling Psychologist. The psychological assessment group was charged with the tasks of: (a). identifying the core components of psychological assessment competency; (b). determining the central educational and training experiences that will aid competency development; (c). explicating strategies for evaluating competence; and (d). establishing future directions for furthering the identification, training, and evaluation of competence in psychological assessment. We present a set of eight core competencies that we deemed important for achieving psychological assessment competency and discuss four guidelines for training in the domain of psychological assessment. A variety of methods for evaluating competencies in this domain are suggested, with emphasis on using a collaborative model of evaluation. Recommendations for future directions include strengthening the academic prerequisites for graduate school training; increasing training in culturally sensitive measures; incorporating innovative assessment-related technologies into training; and addressing discontinuities between academic training, internship, and practice environments.

Competency-Based Education↗
PubMedDate not supplied

Health care delivery system in Australia and its effect on surgical education and training.

Surgical education and training in Australia and New Zealand are based on 6-year undergraduate medical curricula covering the scientific foundations of medical practice. One-year rotating internships are required in all states of Australia to allow medical graduates to satisfy statutory requirements for completing basic medical education prior to gaining credit for training within a specialty. The Royal Australasian College of Surgeons defines the duration and content of training as well as the standards of supervision and guidance that enable surgical trainees to satisfy the requirements leading to Fellowship of the Royal Australasian College of Surgeons. Licensing authorities in several states and the Commonwealth of Australia recognize the award of Fellowship of the Royal Australasian College of Surgeons as sufficient evidence of competence to practice as a specialist surgeon. No formal process of recertification of surgical competence has yet been promulgated in Australia.

Australia↗
PubMedDate not supplied

Swedish health care delivery system and its effects on surgical education.

Sweden, with a small, decentralized population, has a similarly decentralized network of hospitals that comprise the national health care system, which is nonetheless highly regulated by the national government. Medical education and graduate training in surgery are likewise regulated. Reforms implemented in 1992 made a 21-month general rotating internship mandatory for all medical graduates, after which they enter specialty training. The training, which lasts a minimum of 5 years, is done under the tutelage of a Board-certified practitioner in the field. During the trainee and program contract for the amount of time spent in clinical and didactic experiences, the trainee is personally responsible for ensuring that much of his or her individual program is accomplished. Rising health care costs have spurred increased rationalization of resources and are expected to constrict training opportunities for future surgeons.

Delivery of Health Care↗
PubMed1993

Perception of power among dietitians.

Power is a new concept in the field of nutrition that has increasing relevance for the survival of the profession in the 1990s. This study reports on dietitians' perception of power. A survey questionnaire was mailed to all members of the New Jersey State Dietetic Association (1,969 members). Usable responses were obtained from 521 dietitians (a response rate of 27%). The majority of respondents were female, married, and younger than 40 years of age; 37% were in clinical positions and 62% had completed internship and master's degree programs. Respondents rated power as very important (30%) or important (44%), and the terms accomplishments, control, intelligence, and connections were key descriptors of power. Power was felt to be acquired through knowledge, education, and position/title. The positions of department head, chief clinical dietitian, and nutrition support dietitian ranked in the middle of a power hierarchy. The top positions were chief executive officer and physician, and the bottom position was tray-line worker. Responses to "power" scenarios showed greater professional concern (60%) than personal concern (35%) over a clinical scenario (loss of control of the nutrition formulary) than a managerial scenario (threatened layoffs) (38% and 32%, respectively). Dietitians need to focus on and understand the concept and realistic use of power in the workplace. Initially, basic concepts and skills related to power must be incorporated into dietetics and continuing education using a gender-focused teaching approach.

Dietetics↗
PubMed1994

Education in clinical biochemistry: the Canadian scene.

The Canadian Health Care System is operated governmentally at the provincial level although the costs and benefits are similar in every province. Most physicians are remunerated on the 'charge per service' basis, but laboratory physicians (including medical biochemists) are among the few who are remunerated by salary. The training of medical biochemists is regulated by the Royal College of Physicians and Surgeons of Canada by means of a residency program of 4 years duration, following graduation from medical school and completion of the required internship. The training of clinical biochemists, whose functions overlap many of those attributable to medical biochemists, is regulated by the recently created Canadian Academy of Clinical Biochemistry through a certification process incorporating written and oral examinations approximately 1 year apart. Recognized and accredited training programs for clinical biochemists exist in several medical schools: these courses are of 2 (occasionally 3) years duration and entry to these programs requires a Ph.D. and, preferably, some post-graduate research experience. Details of both medical and clinical biochemistry training programs reveal a difference in emphasis and duration rather than in course content, with medical trainees required to spend at least 1 of their 4 training years in clinical disciplines relevant to the practise of biochemistry.

Biochemistry↗
PubMed1983

Psychosomatic education in Turkey.

Psychosomatic education during medical study is achieved within psychiatry courses in Turkey. Generally, postgraduate education in psychiatry provides, during the specialization period, also a certain amount of education in psychosomatics. Only the Cerraphasa Medical Faculty at Istanbul University presents a unique form of practice and educational activity in the field of psychosomatics. Here, the Psychoneuroses and Psychosomatics Department within the Psychiatry Clinic (the foundation of which goes back to 1970) provides for medical students a psychosomatic approach and an introduction to psychosomatic concepts within the medical psychology courses and a further theoretical as well as practical knowledge during the psychiatry courses and internships. Postgraduate training in psychosomatics is also unique for Turkey in this department, where psychiatry residents with special interest for psychosomatics spend the major part of their training period in the psychosomatics department and receive theoretical and practical training. Training in psychotherapy is also included in the program. The regular series of seminars and open-lectures organized by this department are directed also to other medical and non-medical staff in various departments and faculties. Consultation-liaison-psychiatry is also part of this training. The department provides under- and postgraduate training (master training) for psychologists. Nurse training (under- and postgraduate) and occupational therapist training are also included in the training program of this Department. The training as well as other therapeutic and research activities of this department are also supported by the Society of Psychosomatics and Psychotherapy.

Curriculum↗
PubMed1983

Covert and overt forms of maltreatment in the preschools.

This paper examines the preschool environment, finding within it forms and patterns of maltreatment. The preschool is defined as an educational facility for children 2 1/2 to 5 years. Described are the major models of preschools, public and private, conservatively estimated at 50,000 in the United States. The study is based on data from observations by the author of 60-70 preschools in the New York City metropolitan area, 1976-1981. This five-year period witnessed a substantial increase in the preschool movement. Explored are factors related to this increase, one significant factor being the idea that early childhood education can never be too early. Demand for early academic competence in young children when combined with longer time periods spent in preschools creates difficulties for children. Societal pressure upon preschool teachers to produce cognitively and emotionally competent young children while assuring their health and safety needs leads to outcomes which are cause for concern. Covert forms of maltreatment lie predominantly in staff (directors, teachers, assistants) attitudes toward young children. These include: insistence that children learn to be independent while reinforcing dependent behavior; overemphasis on the acquisition of academic skills, irrespective of age; excessive reliance on packaged "educational" materials; non-use of materials that have intrinsic interest for children; lack of enthusiasm for working with young children; rigid adherence to routine for convenience; dislike of particular children. Overt forms of maltreatment to gain compliance or obedience from young children range from direct verbal attack (insult, sarcasm, ridicule, threats, name calling, humiliation) through emotional abuse (withholding of affection or compassion) to clear physical coercion (pulling, pushing, shoving, yanking, expulsion from class, isolation in class). Such patterns are not limited to a particular model but can occur in each preschool category. Their significance suggests that caring for and educating young children in group settings may not be the panacea society wants it to be. Special preparation for early childhood educators with well supervised internships is certainly a forward step, among many others, which are cooperatively needed at this juncture to improve the preschool environment for all children.

Attitude↗
PubMed1979

Current attitudes of medical students and house staff toward terminal illness.

A survey questionnaire about attitudes toward terminal illness was administered to all medical students, interns, and all medical, surgical, and psychiatric residents at the Downstate Medical Center. The majority of students and new physicians surveyed reported that patients with terminal illness should be told their diagnosis--a reversal of attitudes as compared with those revealed by studies done before 1970. Most of the respondents also expressed the view that they would want to be told of their own fatal illness. The attitudes at different levels in medical school, internship, and residency did not differ significantly despite the differences in formal education and clinical experience of the respondents. Implications of these findings are discussed with particular emphasis on the need to teach an individualized approach to the dying patient.

Attitude of Health Personnel↗
PubMed1985

The Hannover Consultation Liaison model: some empirical findings.

Starting from the definitions concerning the concepts 'Liaison medicine' and 'Consultative Psychiatry' we begin with remarks with regard to the Consultation Liaison-Situation in West Germany on the basis of the key-words 'Brief history', 'Independent university units with regard to Psychotherapy and Psychosomatics as well as the connected organization' and 'Teaching procedures'. Following it the Hannover Consultation Liaison model is presented particularly with regard to both the psychosomatic inpatient ward including the functional organization and psychotherapeutic processes as well as the so-called 'Innere Ambulanz' which includes the consultation liaison services in the clinico-medical departments outside Psychiatry and Psychosomatics. Within the 'Innere Ambulanz', which is closely connected to our psychosomatic inpatient ward, the consultation liaison activities and the resulting supportive psychotherapeutic strategies are performed by student auxiliary therapists who are interested in completing their 4-5 months internship-time in our department. We describe both the three supportive psychotherapeutic steps, which may last months to years including subsequent dynamically psychotherapeutic strategies as well as the reactions of the auxiliary therapist function on the students. Furthermore, we may state that there exists no one more optional education procedure of graduate students than the student's confrontation with his partial self-responsibility vis-à-vis a patient who is being supportive-psychotherapeutically treated by him. Specific empirical proofs concerning our patient oriented consultation liaison activities are demonstrated on the basis of previous psychotherapeutic findings in Crohn patients. Here we are able to demonstrate the effectivity of psychotherapy in the case of the supplementarily psychotherapeutically treated patients in comparison to the patients who received medical therapy only. Finally we are able to present quantitative clinico-medical inpatient needs with regard to consultation liaison activities starting from our 'Innere Ambulanz'. On the basis of our conservative estimate, 31-42% of patients showed severe psychosomatic or psychic symptoms who should be treated by psychological means in addition to the medical treatment.

Anxiety Disorders↗
PubMed1993

Medical slang and its functions.

Medical slang is analyzed in the developmental perspective of the physician's career. More than 300 terms gathered by ethnographic methods are classified by social categories: (1) the setting--various types of hospitals and facilities, (2) the players--care-givers and care-receivers, (3) the social processes--patient admission, diagnosis, treatment and discharge, and (4) death and dying. Slang usage generally begins during the third year of medical school when students rotate among clinical services and peaks during the internship year. Male and female clinicians are similar in slang usage. Five psychosocial functions of medical slang are discussed.

Adult↗